Mortality According to CD4 Count at Start of Combination Antiretroviral Therapy Among HIV-infected Patients Followed for up to 15 Years After Start of Treatment: Collaborative Cohort Study.
- May MT Schoolof Social and Community Medicine, University of Bristol, United Kingdom.
- Vehreschild JJ Clinical Trials Unit II Infectious Diseases, University of Cologne, Germany.
- Trickey A Schoolof Social and Community Medicine, University of Bristol, United Kingdom.
- Obel N Department of Infectious Diseases, Copenhagen University Hospital, Denmark.
- Reiss P Department of Global Health, Academic Medical Center, University of Amsterdam, and Amsterdam Institute of Global Health and Development HIV Monitoring Foundation.
- Bonnet F Bordeaux University, ISPED, INSERM U897.
- Mary-Krause M Sorbonne Universités, UPMC Université Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France.
- Samji H Division of Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.
- Cavassini M Service of Infectious Diseases, Lausanne University Hospital and University of Lausanne, Switzerland.
- Gill MJ Division of Infectious Diseases, University of Calgary, Canada.
- Shepherd LC Research Department of Infection and Population Health, University College London Medical School, United Kingdom.
- Crane HM Center for AIDS Research, University of Washington, Seattle.
- d'Arminio Monforte A Monforte Clinic of Infectious Diseases and Tropical Medicine, San Paolo Hospital, University of Milan, Italy.
- Burkholder GA Division of Infectious Disease, Department of Medicine, University of Alabama, Birmingham.
- Johnson MM Department of HIV Medicine, Royal Free London NHS Foundation Trust, United Kingdom.
- Sobrino-Vegas P Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid.
- Domingo P Department of Medicine, Autonomous University of Barcelona, Spain.
- Zangerle R Medical University Innsbruck, Austria.
- Justice AC Yale University School of Medicine, New Haven.
- Sterling TR Vanderbilt University School of Medicine, Nashville, Tennessee.
- Miró JM Hospital Clinic-IDIBAPS, University of Barcelona, Spain.
- Sterne JAC Schoolof Social and Community Medicine, University of Bristol, United Kingdom.
- Boulle A
- Stephan C
- Miro JM
- Cavassini M
- Chêne G
- Costagliola D
- Dabis F
- Monforte AD
- Del Amo J
- Van Sighem A
- Fätkenheuer G
- Gill J
- Guest J
- Haerry DH
- Hogg R
- Justice A
- Shepherd L
- Obel N
- Crane H
- Smith C
- Reiss P
- Saag M
- Sterling T
- Teira R
- Williams M
- Zangerle R
- Sterne J
- May M
- Ingle S
- Trickey A
- 2016-03-31
Published in:
- Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. - 2016
CD4 count
HIV
antiretroviral therapy
cohort collaboration
mortality
Adolescent
Adult
Anti-Retroviral Agents
CD4 Lymphocyte Count
Cohort Studies
Female
HIV Infections
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Young Adult
English
BACKGROUND
CD4 count at start of combination antiretroviral therapy (ART) is strongly associated with short-term survival, but its association with longer-term survival is less well characterized.
METHODS
We estimated mortality rates (MRs) by time since start of ART (<0.5, 0.5-0.9, 1-2.9, 3-4.9, 5-9.9, and ≥10 years) among patients from 18 European and North American cohorts who started ART during 1996-2001. Piecewise exponential models stratified by cohort were used to estimate crude and adjusted (for sex, age, transmission risk, period of starting ART [1996-1997, 1998-1999, 2000-2001], and AIDS and human immunodeficiency virus type 1 RNA at baseline) mortality rate ratios (MRRs) by CD4 count at start of ART (0-49, 50-99, 100-199, 200-349, 350-499, ≥500 cells/µL) overall and separately according to time since start of ART.
RESULTS
A total of 6344 of 37 496 patients died during 359 219 years of follow-up. The MR per 1000 person-years was 32.8 (95% confidence interval [CI], 30.2-35.5) during the first 6 months, declining to 16.0 (95% CI, 15.4-16.8) during 5-9.9 years and 14.2 (95% CI, 13.3-15.1) after 10 years' duration of ART. During the first year of ART, there was a strong inverse association of CD4 count at start of ART with mortality. This diminished over the next 4 years. The adjusted MRR per CD4 group was 0.97 (95% CI, .94-1.00; P = .054) and 1.02 (95% CI, .98-1.07; P = .32) among patients followed for 5-9.9 and ≥10 years, respectively.
CONCLUSIONS
After surviving 5 years of ART, the mortality of patients who started ART with low baseline CD4 count converged with mortality of patients with intermediate and high baseline CD4 counts.
CD4 count at start of combination antiretroviral therapy (ART) is strongly associated with short-term survival, but its association with longer-term survival is less well characterized.
METHODS
We estimated mortality rates (MRs) by time since start of ART (<0.5, 0.5-0.9, 1-2.9, 3-4.9, 5-9.9, and ≥10 years) among patients from 18 European and North American cohorts who started ART during 1996-2001. Piecewise exponential models stratified by cohort were used to estimate crude and adjusted (for sex, age, transmission risk, period of starting ART [1996-1997, 1998-1999, 2000-2001], and AIDS and human immunodeficiency virus type 1 RNA at baseline) mortality rate ratios (MRRs) by CD4 count at start of ART (0-49, 50-99, 100-199, 200-349, 350-499, ≥500 cells/µL) overall and separately according to time since start of ART.
RESULTS
A total of 6344 of 37 496 patients died during 359 219 years of follow-up. The MR per 1000 person-years was 32.8 (95% confidence interval [CI], 30.2-35.5) during the first 6 months, declining to 16.0 (95% CI, 15.4-16.8) during 5-9.9 years and 14.2 (95% CI, 13.3-15.1) after 10 years' duration of ART. During the first year of ART, there was a strong inverse association of CD4 count at start of ART with mortality. This diminished over the next 4 years. The adjusted MRR per CD4 group was 0.97 (95% CI, .94-1.00; P = .054) and 1.02 (95% CI, .98-1.07; P = .32) among patients followed for 5-9.9 and ≥10 years, respectively.
CONCLUSIONS
After surviving 5 years of ART, the mortality of patients who started ART with low baseline CD4 count converged with mortality of patients with intermediate and high baseline CD4 counts.
- Language
-
- English
- Open access status
- hybrid
- Identifiers
-
- DOI 10.1093/cid/ciw183
- PMID 27025828
- Persistent URL
- https://sonar.ch/global/documents/43255
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